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PEF�MIT APPLlCATIC�N <br /> CITY OF EVERETT PERMIT S�R�'ICeS <br /> 3200 CEDAR STREET, EVERETT,v✓A 98201 <br /> 425-257-8810– FAX 425-257-8857–www•everettwa.org <br /> qPP .ICATIONS ARE ACCEPTEU FROM 8 AWI 10 4 PM 3 �� —O� <br /> SITE ADDRESS PARCcy.TAX I.D.� PERMIT# <br /> tr�C 1C tl�Gc l�/',or ��;�'�a,��DJ �-;a/ �? � �C'�b3-� <br /> LEGAL LOT NO. ALOCK TRAC'f OR SUBDIVISION# - i <br /> DESC. <br /> O/W�NER <br /> ADDRESS CINIZIP PHON[ t�l$� <br /> l.�flf5ri ��d�L� li(,' iL �Iri ��/.,E �E� E✓c%('i� Jli�e' 737- /dOc' <br /> TENANTNAME <br /> CONTACTFORPERMIT PHONE I <br /> E-MAIL _— I <br /> - ADDRESS CITYIZIP PHONE <br /> CONTRACTOR � <br /> CONTR.LICENSE# <br /> IUSE OF BUILDING I H[AT SOURCE I CONTRACT PRICE OF WORK <br /> f� .�V�1 �r, ,�,L,/ ��r I _Eleclric �Gas_Olher <br /> WORK DESCRIPTION <br /> ����.J,� ��t��, ) y �,,,�. �.sr-f:v���� , <br /> P;_UMBINr, MECHANICA� <br /> NO. <br /> NPE OF Fi�T��RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> A/C-air handlin9 unifs <br /> Toilet Forced air systems <br /> _ Bathtub Gas piping <br /> Lavalory(wash basin) — Water healer <br /> _ Shuwer Gas fireplace <br /> Kitchen sink 8 disposal Gas range <br /> _ Dishwasher Clolhes dryer <br /> _ Clolhes washer Range hood <br /> Water healer Exhaust fan <br /> I — Sink(servicelbar/mop.�elc.) = Heat pump <br /> � Backflow preventer Unit healer �, �J' � <br /> Urinal Boiler <br />�� ;��.. — Drinking Founlain � — Refi;geralion <br /> �I � F!oordrain Woodstove <br /> Grease Uap Otner _ <br /> Roof drains — — <br /> = Olher I _ - _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 31U5 _ I <br /> I hereby cerilify lhat I have read and examined lhis applicaiion and know the same ro 6e true and correcL All provisions of laws and <br /> ordinaces goveming this type of work will 6e complied with whether specifi�d herein or noL The granling of a permit does not presume <br /> lo c�ive aulhority lo violale or cancel tlie provision of any olher stale or local law regulating construct'�n or the perfoimance of <br /> conslruclion.Thal I am�yulhorixed by lhe owner of lliis property lo pedorm ihe nr�for which appli�ation is made and I compty wilh;;�e <br /> Slale Contractors LaW 18.27 , and 23G200 WAC. <br /> � � �� <br /> - 3 <br /> � i <br /> SignaWre of Jwner/Con todA ri d Ac�ent �a1e I <br /> l <br /> � � . <br />